Given the pervasive fear of a drawn-out death, perhaps...

COPING: MORTAL MATTERS

Given the pervasive fear of a drawn-out death, perhaps it's not surprising that a how-to book on suicide has shot to the top of the New York Times best-seller list for hardcover advice books.

"Final Exit" by Derek Humphry, president of the Hemlock Society, has become a phenomenon, even prompting a front-page story in the New York Times.

It has also become a warning that the public may be far ahead of physicians, ethicists, lawyers and policy-makers in their eagerness to come to terms with the issues that now define the American way of death.

Sales figures for "Final Exit" suggest Americans are impatient with the debates about euthanasia and physician-assisted suicide.

As they see it, the issue is simple: individual choice and control over one's own life.

"Final Exit" draws attention to one aspect of the right-to-die debate that has not gotten as much attention from the courts or state legislatures as have cases involving people on life-prolonging machines. For these people, dying is a matter of deciding when or whether to pull the plug.

In contrast, as author Derek Humphry says, "Final Exit" is written for people who are terminally ill, who are not on life-support systems, but who want some control over the timing of their death.

"Final Exit" is not the Hemlock Society's first book to explain how to commit suicide. Mr. Humphry's 1981 book, "Let Me Die Before I Wake," contained similar information, but it was couched in 10 case studies.

"Final Exit" is more straightforward and practical. Moreover, as Mr. Humphry says, "I've learned a lot over 11 years of running the Hemlock Society. This is the distillation of that knowledge: advice on techniques, on not hurting people, on insurance and legal matters."

The decade between the publication of "Let Me Die Before I Wake" and "Final Exit" has apparently brought a vast change in public opinion about euthanasia. The 1981 book has sold steadily, with about 25,000 sales a year. But in its first months, "Final Exit" has sold 160,000 copies, and orders are still coming in. Publishers in 13 countries have asked to reprint the book.

The book's popularity has raised alarms in many quarters. After all, given the prevalence of suicide and its disastrous effects on families and friends, is it wise to print an instruction manual? Many people think not.

The Hemlock Society defends the book by pointing out that the drugs needed to carry out their instructions can be obtained only through a doctor and that, for instance, distraught teen-agers would not be able to use this book to end their lives.

Even so, any book could be open to abuse, especially one as explicit as this. But at this point, objections to the book sound a bit like crying over spilled milk. Obviously, "Final Exit" is going to be around for a while.

It's also clear that the issue of physician-assisted suicide can no longer be brushed under the rug. In November, Washington state will vote on an initiative that would, among other things, protect physicians from prosecution for helping a patient to die.

"Doctors help bring us into this world," Mr. Humphry says. "If we are terminally ill, we are suffering unbearably and we request the help, it is perfectly proper for a doctor to help us to die. It's cowardice for doctors to hide behind the Hippocratic oath."

He cautions that such help should come only from physicians who know the patient well, and who have a strong, warm relationship.

Do you think doctors should be able to help terminally ill patients who request their assistance in dying? Send your comments and questions to Sara Engram, Mortal Matters, The Evening Sun, P.O. Box 1377, Baltimore 21278.